Category: Cardiovascular Health

  • Blood Pressure Is the Most Important Number You’re Ignoring

    Blood Pressure Is the Most Important Number You’re Ignoring

    When people talk about longevity, they usually mention things like cold plunges, mushroom powders, or the latest supplement that “everyone in Silicon Valley is taking.” But if you ask most doctors,  the kind who deal with real patients, not just podcasts, the top of the list is something far less glamorous, blood pressure.

    Blood Pressure: The Silent Killer That’s Surprisingly Common

    High blood pressure, or hypertension, is often called the silent killer. And for good reason. It doesn’t usually cause symptoms. There’s no rash, no pain, no warning light. But over time, it quietly raises your risk of heart attacks, strokes, kidney disease and dementia.

    When it comes to blood pressure, there’s a simple rule worth remembering. It’s known as the “Rule of Halves”:

    • About half of all adults have high blood pressure.
    • Half of those are undiagnosed.
    • Half of those who are diagnosed aren’t treated.
    • And half of those treated aren’t treated properly.

    That’s a lot of people wandering around thinking they’re in good shape because they “feel fine.”

    But I Had My Blood Pressure Checked at My GP Surgery…

    Let’s talk about how blood pressure is usually measured. You sit in a clinic. You’ve walked fast to get there or worried about parking wardens, probably had a coffee beforehand. Someone wraps a cuff around your arm and tells you to relax.

    That one-off reading might be useful, but it’s also a bit like checking the weather by glancing out the window for five seconds. You’re not getting the full picture.

    Enter the Hilo Band

    The Hilo Band is a wearable device that takes a different approach. It uses photoplethysmography (PPG),  a light-based sensor on your wrist, to monitor the shape and flow of your pulse wave. It’s not just counting your pulse. It’s analysing how your blood pressure behaves throughout the day and night using Pulse Wave Analysis (PWA).


    Hilo gives you multiple readings over 24 hours, including while you sleep. And the band only records when you’re still, which improves accuracy. It’s like having a calm, unobtrusive nurse quietly checking your pressure in the background. And yes, it looks good too. Like a minimalist fitness tracker had a child with a hipster bracelet.

    Real Life Data, Not Waiting Room Guesswork

    This continuous monitoring means you get a clearer, more accurate view of your blood pressure patterns. As opposed to a single, possibly elevated reading in a GP’s office. It can help catch masked hypertension (normal readings in clinic but high at home) or white coat syndrome (high in clinic, normal elsewhere).

    That matters because earlier detection means earlier action, which can include everything from lifestyle tweaks to proper medication, guided by real-world data rather than guesswork.

    Blood Pressure and Longevity: The Real Biohack

    If you’re serious about healthspan (although I hate that word as it sounds like management consultant jargon!), not just how long you live, but how well, then keeping your blood pressure in check is arguably more effective than most so-called biohacks.

    You don’t need exotic pills or 18-step routines. You need good sleep, a Mediterranean-ish diet, regular movement… and control of your blood pressure.

    If you’re going to invest in a wearable, make it one that actually improves your health, not just a random, clinically meaningless “health score.”

    If you’re ready to try it, check them out here: Hilo Band

    Blood pressure control isn’t new or flashy. But it works. And with a tool like the Hilo Band, it’s easier than ever to track, understand and act on. Because knowing your numbers, in your real life, not just under fluorescent clinic lights, is one of the smartest longevity moves you can make. 

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Cardiovascular Health Guides
  • Why ApoB Matters For Your Heart Health

    Why ApoB Matters For Your Heart Health

    If you care about your heart, then you’ve probably been told to keep an eye on your cholesterol. For decades, low-density lipoprotein cholesterol (LDL-C) has been the poster child for cardiovascular risk. The higher your LDL-C, the higher your risk of heart attack and stroke. So we measure it, we target it, and we try to lower it.

    However, it is little known that LDL-C is just a proxy. What actually damages arteries is not the cholesterol floating around your blood, but the particles that carry it. Each of those particles has, on it’s surface, a protein called apolipoprotein B (apoB). The more apoB particles you have, the more chances they have to burrow into your artery walls and trigger atherosclerosis.

    ApoB is, in effect, a headcount of all the atherogenic particles in your blood. For years, evidence has been mounting that it is a better marker of risk than LDL-C. In 2019, European guidelines even stated that apoB was more accurate, easier to measure, and more precise. And yet LDL-C still reigns supreme in clinical practice.

    Why isn’t ApoB used more in clinical practice?

    The reason Apob is not used more frequently in current clinical practice is partly inertia. It is also partly habit. And it is partly the argument that LDL-C and apoB are so highly correlated, it makes no practical difference. If you lower one, you lower the other. So many cardiologists and primary care doctors would argue, why bother changing the guidelines?

    A new UK Biobank study has put that argument to bed.

    What this new study found about ApoB

    Researchers followed nearly 300,000 healthy adults for 11 years. They looked at LDL-C, non-HDL cholesterol, triglycerides and apoB, and tracked how each one related to future heart attacks and strokes.

    Yes, LDL-C and apoB were highly correlated. But the correlation was not perfect. At any given LDL-C level, individual apoB levels varied widely. Two people could have the same LDL-C, but one might have far more apoB particles quietly driving up their cardiovascular risk.

    Across every LDL-C or non-HDL-C level, people with higher apoB levels had significantly more cardiovascular events. ApoB gave extra risk information that LDL-C or non-HDL-C simply missed.

    When the researchers ran adjusted statistical models, apoB consistently came out on top as the stronger predictor of risk. LDL-C added no meaningful information once apoB was taken into account.

    Triglycerides too? Same story. ApoB still won.

    Some guidelines only recommend testing apoB if your triglycerides are high. The idea is that apoB might only be useful in those cases, when cholesterol particles are small and harder to measure accurately using standard tests. But this study found no support for that.

    In fact, apoB was consistently useful regardless of triglyceride levels. Even when triglycerides were taken into account, apoB still gave meaningful extra information about risk. The reverse wasn’t true. Once you knew someone’s apoB, their triglyceride level didn’t add much.

    This suggests apoB is giving us more useful insight, across the board, not just in people with high triglycerides.

    Because in clinical practice, we are treating individual patients, not population averages. Knowing your apoB level helps tailor your treatment far more accurately. Without it, there is too much guesswork. Two patients with the same LDL-C could have very different numbers of atherogenic particles, and very different risk.

    We now have safe and powerful therapies, from statins to PCSK9 inhibitors. But they are costly and need to be used wisely. ApoB is the best tool we have to target those therapies to the right people.

    Why has ApoB not been widely adopted yet?

    One argument that is frequently given is cost. But measuring apoB is inexpensive. In the US, it would raise lipid testing costs by about 1 percent. And in reality, once apoB is used, there is little need to keep measuring LDL-C or non-HDL-C, so the total cost of care need not rise.

    Another barrier is familiarity. Doctors and labs are used to ordering LDL-C. Changing habits takes time. But with evidence like this, the argument for change is becoming hard to ignore.

    ApoB is the best available measure of atherosclerotic risk. LDL-C and non-HDL-C are imperfect stand-ins. If you want the most accurate picture of your cardiovascular risk, you should know your apoB.

    If you are already on treatment, it is the best way to know if your therapy is working. If you are not yet on treatment but considering it, it can help you and your doctor make a better-informed decision.

    If guidelines and clinical practice catch up to the evidence, we will prevent more heart attacks and strokes. And that, surely, is the whole point.

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Cardiovascular Health Guides
  • High Blood Pressure: The Longer You Have It, The Worse It Gets

    High Blood Pressure: The Longer You Have It, The Worse It Gets

    Walk into any supermarket and try to avoid ultra-processed foods. It’s nearly impossible. Ready meals, packaged snacks, ‘healthy’ protein bars, and supermarket bread. They all fall into this category. Even some foods marketed as nutritious are ultra-processed, full of additives, preservatives, and ingredients that barely resemble anything found in nature.

    We’ve long suspected they’re bad for us. But a massive new study has put the nail in the coffin. The more ultra-processed food you eat, the worse your health outcomes. Heart disease, obesity, type 2 diabetes, depression, and even early death; the risks go up across the board.

    High blood pressure (hypertension) is often called the “silent killer.” But let’s be honest, it’s not that silent. Your doctor has probably mentioned it. Maybe you’ve been told to “keep an eye on it” or “try to reduce your salt intake.” The problem is that by the time hypertension gets serious, it’s been quietly causing damage for years.

    A major new study has confirmed what many of us suspected. The longer you have hypertension, the worse the outcomes. The study looked at over 27,000 people and found that the duration of high blood pressure, not just the level, plays a crucial role in stroke risk and how hard it becomes to control.

    So, if you’ve been thinking, “I’ll deal with it later,” this one’s for you.

    The Key Findings: More Time, More Risk

    The study found three big problems with having high blood pressure for longer:

    1. Your stroke risk goes up.
      • People with high blood pressure for less than 5 years had a 17% higher risk of stroke.
      • Between 6-20 years, the risk jumps to 48% higher.
      • Over 21 years and the risk skyrockets to 86% higher.
    2. The takeaway is that high blood pressure isn’t just about the number on a screen. The longer your body has been under pressure (literally), the more likely you are to suffer a stroke.
    3. It gets harder to control.
      • The longer you’ve had hypertension, the more medication you need to keep it in check.
      • People with high blood pressure for less than 5 years were on 1.7 different meds.
      • Those with 6-20 years were on 2.0 meds.
      • Those with 21+ years? They needed an average of 2.3 different medications just to manage their numbers.
    4. Translation: If you develop hypertension early and don’t take action, it’s a one-way street to more pills and more complications.
    5. Even with meds, your blood pressure stays higher.
      • Longer hypertension = higher blood pressure, even with treatment.
      • This means more strain on your heart, arteries, brain, and kidneys.

    What You Can Do Right Now

    You don’t need to wait for a GP to tell you your blood pressure is creeping up. Here’s what you can do today:

    1. Get it checked.
    2. Move your body.
    3. Eat real food.
      • Ditch ultra-processed foods (see our last blog).
      • More potassium-rich foods like leafy greens, bananas, and nuts.
      • Cut back on salt, but don’t obsess.
    4. Strength train.
    5. Sleep properly.
    6. Sort out stress.

    Final Thought: Prevention > Treatment

    High blood pressure isn’t something that “just happens” when you get older. It’s the result of decades of lifestyle and genetic factors adding up.

    The best time to take action is before blood pressure rises. The second best time is now. 

    The longer you wait, the harder it gets to manage. But the good news? Even small changes can make a huge difference.

    What Should You Do?

    You don’t need to live like a monk. But cutting back on UPFs is one of the best things you can do for your health. Here’s how:

    • Stick to real food: If it had a face, grew from the ground, or needed little intervention before reaching your plate, it’s a good choice.
    • Shop the perimeter of the supermarket: That’s where you’ll find meat, fish, eggs, fruit, veg, and dairy.
    • Check the ingredients list: If it reads like a chemistry experiment, think twice.
    • Cook more at home: It doesn’t have to be complicated. Simple meals with whole ingredients will always beat processed alternatives.
    • Follow the 80/20 rule: You don’t have to eliminate UPFs completely, but they should be an occasional treat rather than a daily staple.

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Cardiovascular Health Guides
  • Tomatoes: A Natural Way To Improve Blood Pressure

    Tomatoes: A Natural Way To Improve Blood Pressure

    In the world of nutritional science, we often see people narrow focus to single nutrients. While I’m generally not a fan of this approach, a recent study on tomatoes and their potential to combat high blood pressure has caught my attention, and it’s really quite compelling.

    The PREDIMED Study: Tomatoes Blood Pressure Benefits

    The PREDIMED trial is an exploratory analysis involving 7,056 participants who have high blood pressure. It delivered some fascinating insights into the role of tomatoes in managing blood pressure. Who knew that these red fruits, often mistaken for vegetables, could improve cardiovascular health?

    Tomatoes vs. Hypertension: What the Data Says

    Participants in the study were grouped based on their tomato consumption, from the least (<44 g) to the highest (>110 g). Over three years, those with the highest intake showed a remarkable 36% reduction in the risk of developing hypertension compared to those who ate the least.

    The Science Behind the Scenes

    The secret sauce here seems to be lycopene, a potent antioxidant found abundantly in tomatoes. Around 85% of our lycopene intake comes from tomatoes and their derivatives. Lycopene is excellent at neutralising free radicals – those unstable molecules that cause cellular damage and contribute to various health issues, including hypertension.

    Lycopene’s Broader Impacts

    Beyond just mopping up free radicals, lycopene also plays a role in inhibiting the ACE enzyme, which is involved in blood pressure regulation. This dual action of lycopene not only helps in reducing hypertension but also has implications for broader cardiovascular health.

    Alternatives to Tomatoes for Lycopene Intake

    If you’re not a tomato fan, don’t worry. Lycopene is also found in pink grapefruits, pink guavas, watermelons, and papayas. Even processed tomato products like sauces and ketchups are rich in lycopene. The key is to find a balance that suits your palate and dietary preferences.

    The Takeaway: A Step Towards Better Health

    This study reiterates the age-old wisdom about eating fruits and vegetables, with a spotlight on tomatoes. Incorporating them into our diet, provides be a simple yet effective way to manage blood pressure and improve heart health.

    It’s important to remember that nutrition is more complex than single nutrients. But this study on tomatoes and lycopene presents an opportunity to make an impact reducing hypertension rates.

    So next time you’re contemplating your meal choices, remember that adding a splash of red might just be what your heart needs. 

    If you found this blog helpful we would love you to share it with your friends and family

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Cardiovascular Health Guides
  • Does Salt Intake Affect Blood Pressure? New Insights from a Groundbreaking Study

    Does Salt Intake Affect Blood Pressure? New Insights from a Groundbreaking Study

    In the ever-evolving world of dietary recommendations, the role of sodium in blood pressure management has been a subject of fierce debate. A recent study, conducted across two US cities with 213 participants aged 50 to 75, sheds new light on this topic. It is especially useful for those on blood pressure medications.

    Understanding the Sodium-BP Connection

    The study aimed to explore the individual blood pressure response to dietary sodium intake. It analysed variations based on baseline blood pressure and antihypertensive medication usage. The participants, including those with normal blood pressure, controlled, uncontrolled, and untreated high blood pressure, were put on high- and low-sodium diets in a crossover design.

    Dietary Intervention: High vs. Low Sodium

    Participants first adhered to their usual diet, followed by one-week phases of high-sodium (about 2200 mg added daily) and low-sodium (totaling about 500 mg daily) diets. The primary focus was on changes in 24-hour ambulatory systolic and diastolic blood pressure, mean arterial pressure, and pulse pressure.

    Key Findings: A Shift in Blood Pressure

    The results were revealing:

    • Median Blood Pressure Changes: On usual, high-sodium, and low-sodium diets, the median systolic blood pressures were 125, 126, and 119 mm Hg, respectively.
    • Mean Arterial Pressure: The median change in mean arterial pressure between high- and low-sodium diets was 4 mm Hg, significant across all hypertension statuses.
    • Salt Sensitivity: Using the threshold of a 5 mm Hg or greater decline in mean arterial pressure, 46% of participants were classified as “salt sensitive.”

    Consistency Across Subgroups

    Interestingly, the blood pressure decline from a high- to low-sodium diet was consistent across various subgroups, including age, sex, race, hypertension status, baseline BP, diabetes, and body mass index. This suggests that dietary sodium reduction may be beneficial for a wide range of individuals.

    Conclusions: A Relevance for All

    This study reinforces the idea that reducing dietary sodium can significantly lower blood pressure in middle-aged to elderly adults. The reduction in blood pressure was independent of original blood pressure status and blood pressure medication use. This finding is particularly relevant for those seeking non-pharmacological methods to manage blood pressure.

    My Takeaway

    Reducing sodium intake isn’t just for select groups; its benefits extend broadly, offering a universally applicable approach to better blood pressure management. Of course not everyone is a “salt-responder” but if you suffer from high blood pressure then reducing dietary sodium is well worth as try.

    Please help someone else by sharing this blog. 

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Cardiovascular Health Guides
  • The Best Exercise For Managing High Blood Pressure

    The Best Exercise For Managing High Blood Pressure

    High blood pressure, or hypertension, remains a global health challenge, with a soaring prevalence (thanks in part to changing definitions of hypertension) and control often proving elusive. It remains one of the leading modifiable risk factors for disease and death worldwide. While lifestyle interventions have long been a mainstay in hypertension management, a growing body of research underscores the particularly pivotal role of exercise training as an effective non-pharmacological antihypertensive strategy. Recent findings, including a large-scale systematic review and meta-analysis of 270 randomised controlled trials, shed new light on the optimal exercise practices for managing blood pressure. 

    Exercise as a Cornerstone of Hypertension Management:

    The link between exercise and cardiovascular health is certainly not a novel concept. Regular physical activity has long been associated with reduced risks of heart disease and hypertension. However, contemporary research is refining our understanding of how different exercise modalities impact blood pressure.

    The Landmark Study:

    Led by Dr. Jamie J. Edwards and a team of researchers from Canterbury Christ Church University in the United Kingdom, this comprehensive study published in the BJSM examined the effects of various exercise training modes on resting blood pressure. The study analysed 270 randomised controlled trials published between 1990 and February 2023, involving a total of 15,827 participants.

    Key Findings:

    The study’s results paint a clear picture of the effectiveness of different exercise modalities in reducing both systolic and diastolic blood pressure:

    • Aerobic Exercise Training: This traditional form of exercise demonstrated significant reductions in resting systolic blood pressure (SBP) by an average of 4.49 mm Hg and diastolic blood pressure (DBP) by 2.53 mm Hg.
    • Dynamic Resistance Training: Participants engaging in dynamic resistance training experienced reductions in SBP and DBP by an average of 4.55 mm Hg and 3.04 mm Hg, respectively.
    • Combined Training: Combining aerobic and resistance training led to even more pronounced reductions, with SBP decreasing by 6.04 mm Hg and DBP by 2.54 mm Hg.
    • High-Intensity Interval Training (HIIT): HIIT, known for its time-efficient, intense bursts of activity, lowered SBP by 4.08 mm Hg and DBP by 2.50 mm Hg.
    • Isometric Exercise Training (IET): This novel form of exercise emerged as the most effective, resulting in a substantial reduction of SBP by 8.24 mm Hg and DBP by 4.00 mm Hg.

    Optimal Exercise Modes:

    The study ranked the exercise modalities based on their effectiveness, with isometric exercise training (IET) topping the list, boasting a Surface Under the Cumulative Ranking Curve (SUCRA) value of 98.3 percent. Surface Under the Cumulative Ranking Curve, or SUCRA, is a statistical tool used in network meta-analysis to evaluate the relative effectiveness of several different interventions or treatments. In the context of this study, SUCRA values were used to assess and rank the various exercise modalities in terms of their impact on resting blood pressure.

    A higher SUCRA value indicates a greater likelihood that a particular intervention (in this case, an exercise modality) is the most effective among the options being compared. In other words, a higher SUCRA value suggests that an exercise mode is more consistently and confidently ranked as the best choice for reducing blood pressure. Combined training followed closely at 75.7 percent, dynamic resistance training at 46.1 percent, aerobic exercise training at 40.5 percent, and high-intensity interval training (HIIT) at 39.4 percent.

    The Isometric Advantage:

    Isometric exercise training, particularly through activities like isometric wall squats, emerged as the most potent submodes for reducing SBP (SUCRA: 90.4 percent) and DBP (SUCRA: 91.3 percent), respectively.

    Implementing Isometric Training:

    Isometric exercise places the muscle under tension without moving the surrounding joints. To harness the benefits of isometric exercise, use the following protocol:  

    4×2-minute contractions, separated by 1–4-minute rest intervals, performed three times a week. 

    Isometric handgrip (IHG) is usually executed at 30% maximum voluntary contraction, while isometric wall squats (IWS), also known as ski squats can be performed to elicit a rate of perceived exertion (RPE) between 3.5–4.5/10 for the first bout, RPE 5–6/10 for the second bout, RPE 6.5–7.5/10 for the third bout, and RPE 8–9/10 for the fourth bout. Isometric leg extension (ILE) is performed at 20% of the maximum voluntary contraction (this is the maximum amount of force that can be generated by contracting a muscle group). So in practice, this means holding still with the legs fully straightened approximately 20% of the heaviest hold that you could shift on the leg extension machine. 

    As the prevalence of hypertension continues to rise, understanding the role of exercise in its management becomes increasingly critical. The latest research emphasises the varied and substantial benefits of lots of different exercise modalities, with isometric exercise training shining as a particularly potent antihypertensive intervention. Of the isometric exercises, wall squats, to me at least, are the most convenient to perform.

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Cardiovascular Health Guides
  • Unmasking the Hidden Enemy: Inflammation’s role in Cardiovascular Disease

    Unmasking the Hidden Enemy: Inflammation’s role in Cardiovascular Disease

    Cardiovascular diseases (CVDs) have long been a significant health concern, but advancements in statin therapy have helped reduce their impact. However, some patients continue to experience CVD events despite high-dose statin treatment. This is known as residual risk. Recent research suggests that this residual risk may be attributed, in part, to inflammation, which can trigger plaque ruptures. Here, we will delve into inflammation’s role in cardiovascular disease and explore the potential benefits of reducing inflammation using low-dose colchicine.

    Inflammation’s role in Cardiovascular Disease

    Inflammation has emerged as a key player in the development and progression of cardiovascular disease. Dr. Ridker and his team pioneered the use of high-sensitivity C-reactive protein (hs-CRP) testing to identify inflammation in patients. Their study, the Jupiter study, demonstrated the efficacy of rosuvastatin in reducing CV events in high-risk primary prevention patients identified through hs-CRP testing. However, the full potential of the inflammation strategy was not realised at that time and the potential to treat lower-risk patients was missed.

    Uncovering the Link between Inflammation and CV Events

    A recent paper explored the connection between inflammation and CV events by analysing data from three major studies: PROMINENT, REDUCE-IT, and STRENGTH. Patients were divided into quartiles based on their hs-CRP levels, and the highest quartile group was compared to the lowest.

    The results were striking. Patients in the highest hs-CRP quartile experienced a 31% increase in major adverse cardiovascular events (MACE), a 268% increase in cardiovascular mortality, and a 242% increase in all-cause mortality, highlighting the significant impact of inflammation on CV health. Comparatively, the differences in MACE, CV death, and all-cause death were not as pronounced when comparing the highest and lowest LDL-cholesterol (LDL-C) quartiles. 

    The Inflammation Conundrum

    Once patients are on effective statin therapies and their LDL-C levels are well-controlled, the threat posed by LDL-C diminishes. However, the presence of inflammation remains a driving force behind future CV events. Identifying patients with high hs-CRP levels while on high-dose statins becomes essential to intensify efforts in reducing their residual CV risk.

    Addressing Inflammation: A New Frontier in Cardiovascular Health:

    Presently, there are limited affordable therapies proven to reduce inflammation. As a result, it is crucial to prioritise preventive measures that can help combat inflammation and its consequences. Encouraging patients to quit smoking, manage abdominal obesity, reduce stress, improve sleep quality, and adopt a heart-healthy diet can significantly contribute to reducing inflammation and enhancing overall cardiovascular health. 

    The Concern of Inflammation Post COVID-19

    The aftermath of long COVID poses another concern, as inflammation from COVID-19 may also increase the risk of cardiovascular events in a large number of people. Vigilance and proactive management of inflammation in recovering COVID-19 patients are paramount to safeguard their heart health.

    The Power of Low-Dose Colchicine

    Colchicine has been used for centuries to treat joint inflammation and is frequently used to treat gout.  A recent analysis has shed light on the potential of low-dose colchicine, revealing its significant impact in the management of chronic coronary artery disease by reducing inflammation in the coronary arteries. 

    The study conducted an in-depth analysis to model the 10-year and lifetime impact of low-dose colchicine in patients with chronic coronary artery disease. The results were striking, demonstrating that low-dose colchicine has the potential to bring about a median 10-year absolute risk reduction rate of 4.6% for major adverse cardiovascular events (MACE). This reduction in risk translates into gaining 2.0 MACE-free years over a lifetime for patients.

    What makes this finding even more significant is that the estimated 10-year and lifetime benefits of low-dose colchicine are comparable to the benefits associated with intensified low-density lipoprotein cholesterol (LDL-C) and systolic blood pressure-lowering. LDL-C and blood pressure optimisation are well-established strategies in cardiovascular management, and the fact that low-dose colchicine holds similar potential is indeed promising news.

    An exciting opportunity for patients with existing chronic coronary artery disease

    The discovery of the potential benefits of low-dose colchicine presents an exciting opportunity for patients with existing chronic coronary artery disease. By adding this medication to their treatment regimen, they may experience substantial improvements in their cardiovascular health, with a reduced risk of MACE over the long term.

    Low-dose colchicine is well-tolerated and has been used for years to treat conditions like gout. As always, individual patient needs vary, and decisions about treatment should be made in consultation with healthcare providers. When managing chronic coronary artery disease, healthcare providers will consider various factors, including a patient’s medical history, risk profile, and other existing treatments. By adopting a personalised approach to care, patients can receive the most suitable treatment plan that aligns with their unique health requirements.

    Hope for a healthier & heart-protected future

    Inflammation has emerged as a critical factor in the pathogenesis of cardiovascular disease, even when LDL-C levels are well-controlled through statin therapy. Identifying patients with inflammation through hs-CRP testing can help us address their residual CV risk and implement personalised strategies to reduce inflammation. The analysis of low-dose colchicine’s impact on chronic coronary artery disease has revealed its potential to significantly reduce the risk of major adverse cardiovascular events by reducing coronary artery inflammation. The estimated 10-year and lifetime benefits are on par with those of established cardiovascular therapies like LDL-C and blood pressure optimisation. Low-dose colchicine offers an exciting new option for enhancing cardiovascular health, providing patients with hope for a healthier and heart-protected future.

    If you have chronic coronary artery disease

    If you have chronic coronary artery disease, consider discussing the potential benefits of low-dose colchicine with your healthcare provider. Together, you can create a tailored treatment plan that best suits your needs, helping you embark on a journey towards improved cardiovascular well-being. Remember, your heart health is paramount, and with the right care and support, you can take positive steps to protect your heart and live a fulfilling life.

    Please reach out to the team if you have any questions about the contents of this article.

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Cardiovascular Health Guides
  • Unleashing the Power of High-Intensity Exercise: Insights from the CENIT Trial

    Unleashing the Power of High-Intensity Exercise: Insights from the CENIT Trial

    Exercise has long been recognised as a key factor in maintaining a healthy heart and reducing the risk of coronary artery disease (CAD). A recent study called the CENIT trial has provided some valuable insights into the benefits of high-intensity interval training (HIIT) for patients with established CAD. Published in the European Journal of Preventive Cardiology, this research reveals how HIIT can counteract disease progression and promote cardiovascular health. 

    Coronary artery disease occurs when atherosclerosis, or plaque, builds up in the arteries that supply blood to the heart. Over time, plaques can increase in volume and become unstable and rupture leading to a stroke or a heart attack. Atheroma volume, which measures the amount of plaque present in the arteries, is a crucial indicator of CAD severity and has been shown to increase the likelihood of future cardiac events.

    To better understand the impact of exercise on CAD, let’s examine the exercise interventions in the CENIT trial. The study consisted of two groups: the high-intensity interval training (HIIT) group and the control group. Each group had a specific exercise program.

    1. High-Intensity Interval Training (HIIT) Group: Participants in the HIIT group engaged in two supervised exercise sessions per week for a duration of 6 months. Each session began with a 10-minute warm-up at a moderate intensity (around 60% to 70% of peak heart rate). This was followed by four intervals of intense exercise, lasting for four minutes each, at an intensity of 85% to 95% of peak heart rate. Active recovery periods, lasting for three minutes at a moderate intensity, were included between intervals. The sessions concluded with a 5-minute cooldown period. The HIIT sessions involved activities such as walking or running on a treadmill, bicycling, or other exercises that engaged large muscle groups. Participants were encouraged to use a wearable device to track their heart rate and activity levels during the HIIT sessions. This allowed them to maintain the desired intensity and monitor their progress. In addition to the supervised sessions, participants were advised to engage in home-based endurance training. This included performing intervals and any other physical activities that involved dynamic work with large muscle groups.
    2. Control Group: The control group followed contemporary preventive guidelines for physical activity without receiving further supervision. They were encouraged to engage in regular physical activity of moderate intensity for 30-60 minutes on more than 5 days per week. Not only was this exercise not supervised but it was not monitored unlike in the intervention group.

    The CENIT trial focused on the effects of supervised HIIT on coronary plaque geometry in patients with stable CAD who had undergone percutaneous coronary intervention (PCI). Here’s what they found:

    1. Regression of Atheroma Volume: Patients who participated in 6 months of supervised HIIT experienced significant regression in atheroma volume compared to those following standard preventive guidelines. This means that the plaque buildup in their arteries was reduced, potentially lowering their risk of future coronary events.
    2. Improved Cardiorespiratory Fitness: The HIIT group exhibited a significant improvement in peak oxygen consumption (VO2peak), which measures cardiorespiratory fitness. By increasing VO2peak, HIIT enhances the overall health of the cardiovascular system.
    3. Positive Body Composition Changes: Patients in the HIIT group also experienced reductions in body mass index (BMI) and waist circumference. These improvements in body composition are important markers of metabolic health and can contribute to a reduced risk of CAD and related complications.

    The findings from the CENIT trial provide reasonable evidence for the effectiveness of HIIT in managing CAD and improving cardiovascular health. It is, however, difficult to tease out from the study whether it was the supervision of exercise, or wearing a monitor that someone else was tracking or the HIIT that had the greatest benefits. Based on these results, here are some key takeaways to consider:

    1. Consult An Experienced Personal Trainer: If you have established CAD or are at risk for heart disease, consult a very experienced personal trainer who is confident in managing patients who have stable heart disease. They can provide personalised recommendations based on your health status and previous exercise experience.
    2. Embrace High-Intensity Interval Training (HIIT): Consider incorporating supervised HIIT sessions into your exercise routine under professional supervision. HIIT involves short bursts of intense exercise alternated with active recovery periods, making it an efficient and time-effective workout option. But note, the intervention group did not just do HIIT, they also did low-intensity exercise. 
    3. Prioritise Exercise: HIIT’s positive impact on atheroma volume regression, improved cardiorespiratory fitness, and positive body composition changes highlight the importance of exercise as a core component of cardiac rehabilitation programs. When compared to another study looking at the effects of high-intensity statin on plaque lipid volume, high-intensity exercise combined with low-intensity exercise had an effect comparable effect to that of a high-intensity statin.
    4. Monitor Your Exercise: The intervention group wore a wearable and knew they were being monitored. Use a wearable and get an accountability partner to keep you on track. 

    The CENIT trial provides evidence that high-intensity interval training, supervised by a personal trainer and the wearing of a fitness tracker can effectively counteract disease progression and improve cardiovascular health in patients with established coronary artery disease. Participating in supervised HIIT sessions can lead to a reduction in atheroma volume, improved cardiorespiratory fitness, and positive body composition changes.

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Cardiovascular Health Guides
  • Don’t Neglect Your Blood Pressure: Safeguard Your Brain Health

    Don’t Neglect Your Blood Pressure: Safeguard Your Brain Health

    Life is busy. Many of my patients are so busy that they, to paraphrase Gustav Stresemann, are walking “on the edge of a volcano.” It just takes one small event to teeter over the brink. When life is this hectic, it can be easy to neglect something that isn’t causing you any symptoms. Blood pressure is just one of those things. They don’t call it the “silent killer” for nothing. High blood pressure stalks many of us from middle age without us knowing, waiting for an opportunity to push us over the edge. 

    Ignoring your blood pressure in early middle age can have a compound adverse effect on your cardiovascular health. It is a bit like having debt on a credit card that you never get around to paying off but keep spending on in order to accrue the Air Miles. 

    High blood pressure in middle age can have a particular impact on brain health in older age. Almost half of the burden of Alzheimer’s disease and related dementia is due to factors that are within our power to change. High blood pressure is one of the most common of these factors. 

    A recent study conducted by researchers at the University of California has shed more light on the connection between blood pressure and brain health. Their findings underscore the importance of monitoring and managing blood pressure, especially in early adulthood. 

    The study followed a diverse group of participants and found that individuals with hypertension (high blood pressure) or those who transitioned to hypertension in early adulthood had smaller brain volumes and poorer white matter integrity in late life. Interestingly, the negative impact of hypertension on brain volumes was more pronounced in men compared to women.

    Previous research has already indicated a link between hypertension and neurodegenerative conditions such as dementia. This recent study reinforces those findings and highlights the importance of considering hypertension earlier in life, even during early adulthood. Early adulthood hypertension and increases in blood pressure were associated with differences in brain volumes and white matter integrity, which are key indicators of cognitive decline and dementia.

    Notably, the study used updated guidelines for diagnosing hypertension, taking into account lower thresholds for diagnosis. This suggests that even individuals previously classified as having prehypertension or normal blood pressure could still be at risk for neurodegenerative changes associated with dementia.

    The study also uncovered some interesting sex differences. Hormonal factors appear to play a role in protecting women from the detrimental effects of hypertension on the brain, particularly before menopause. Men, on the other hand, seem to experience a stronger negative association between hypertension and brain volumes. The findings of this study emphasise the critical role of managing blood pressure throughout life, starting from early adulthood.

    It’s vital not to overlook the significance of blood pressure management. Just as neglecting credit card debt can result in mounting interest and financial distress, ignoring blood pressure can have a compounding effect on brain health. By regularly monitoring and managing blood pressure, particularly in middle age and early adulthood, you can take proactive steps to protect your brain health and reduce the risk of cognitive decline in later years. Consult with your doctor, make lifestyle changes, and adhere to any prescribed medications to keep your blood pressure in check. 

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Cardiovascular Health Guides
  • Lipoprotein (a): The most important blood test you have never heard of

    Lipoprotein (a): The most important blood test you have never heard of

    25% of people continue to die from cardiovascular and heart disease.

    Despite better modern management of risks like high blood pressure and cholesterol. Researchers suspected that there must be other things causing cardiovascular disease. Studies led to the discovery of a substance in the blood called lipoprotein (a). The level of lipoprotein (a) in the blood is different for everyone. Recent genetic studies proved that you inherit most of your high lipoprotein (a) levels. Your liver manufactures lipoproteins. They are a combination of fat and protein. Their job is to transport fats around the body in the blood. Lipoprotein (a) is a special combination, it includes a lipoprotein like LDL cholesterol, plus two more proteins, apolipoproteins A and B. The combination is very sticky and easily passes into the wall of the artery. This inevitably causes blockages of your blood vessels. So high lipoprotein (a) levels equal a high risk of cardiovascular disease.

    Even people with amazing lifestyles and diets can have high levels. If you are reading this then there is at least a 10 to 20% chance you have a high lipoprotein (a) level. The only way to know your level is through a blood test. Most people only need to check once in their lifetime. High levels mean you are at high risk for heart attacks and stroke. This is true even if your blood pressure and cholesterol levels are “ok”.

    Knowing you are at high risk we can then help you reduce that risk. We will look at all your cardiovascular risk factors and make a plan to optimise these. Knowing about a high lipoprotein (a) level can completely change treatment plans. We need to track your cholesterol measurements. The goals for your cholesterol need to be much lower to reduce your risk. This might mean using medicines to reduce targets like non-HDL cholesterol.

    Ongoing drug trials show great promise. In the future, drugs might directly reduce lipoprotein (a) levels.

    The European Society of Cardiology recommends measuring every adult’s lipoprotein (a) level. Unfortunately in 2022 the British Journal of Cardiology said “most clinicians are unaware of it”. We are passionate about the power of health screening to prevent disease. We recommend testing lipoprotein (a) levels for all adults.  Because levels are mostly genetically determined, it only needs to be checked once. This helps our patients prevent cardiovascular disease. Because prevention is better than cure.

    If you’re interested in learning more about lipoprotein (a) then check out Dr Hugh’s deep dive on lipids here. 

    DR LUCY HOOPER
    MB BS BSc MRCGP MA DRCOG DCH

    Lucy is a GP and co-founder of Coyne Medical. She graduated with honours from Imperial College London, trained at St Mary’s Hospital, and holds a Master’s in Medical Ethics and Law. Her clinical interests span women’s health, preventive medicine, and genomics, with a particular focus on using advanced biomarkers to build a more complete picture of long-term health.

    British Society for Genetic Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in BBC, The Guardian, Women’s Health, The Times and Tatler

    Book a GP Consultation

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Cardiovascular Health Guides